Characterizing hepatitis B virus infection in children in the Democratic Republic of Congo to inform elimination efforts.

Objective: Despite global reductions in hepatitis B virus (HBV) prevalence, an estimated 6.2 million children are infected, two-thirds of whom live in the WHO Africa region. We sought to characterize childhood HBV to inform elimination efforts in the Democratic Republic of Congo (DRC), one of the largest and most populous African countries. Methods: Using the most recent (2013-14) nationally representative Demographic and Health Survey in the DRC, we analyzed HBV surface antigen (HBsAg) on dried blood spots and associated survey data from children aged 6-59 months. We estimated HBsAg-positivity prevalence nationally, regionally, and by potential correlates of infection. We evaluated spatial variation in HBsAg-positivity prevalence, overall and by age, sex, and vaccination status. Findings: Using data from 5,679 children, we found national HBsAg-positivity prevalence was 1.3% (95% CI: 0.9%-1.7%), but ranged from 0.0% in DRC's capital city province, Kinshasa, to 5.6% in northwestern Sud-Ubangi Province. Prevalence among boys (1.8%, 95% CI: 1.2%-2.7%) was double that among girls (0.7%, 95%CI: 0.4%-1.3%). Tetanus antibody-negativity, rurality, and lower household wealth were also significantly associated with higher HBsAg-positivity prevalence. We observed no difference in prevalence by age. Children had higher HBsAg-positivity odds if living with ≥1 HBsAg-positive adult household member (OR: 2.3, 95%CI: 0.7-7.8), particularly an HBsAg-positive mother (OR: 7.2, 95%CI:1.6-32.2). Conclusion: In the largest national survey of HBV among children and household contacts in the DRC, we found that childhood HBV prevalence was 10-60 times the global target of 0.1%. We highlight specific regions and populations for further investigation and focused prevention efforts.

Larval morphology and natural history in two Minervarya species from Andaman Islands, with comments on a new phytotelmonous larval morphotype for the genus.

We studied the larval morphology and natural history of two species of Minervarya from the Andaman Islands of India. A recent assignment of Charles Darwins frog to the genus Minervarya opened up new questions on the systematic affinities and natural history of its enigmatic tadpoles. Originally described as Rana charlesdarwini Das, 1998, and long considered as Ingerana charlesdarwini, the tadpoles of this species were poorly understood and incomparable to those of other presumed close relatives based on an original brief description of its phytotelmonous tadpoles. Here we present a detailed redescription of the larval morphology of M. charlesdarwini based on genetically confirmed tadpoles. At the same time, we compared the external morphology of M. charlesdarwini tadpoles to that of its closest phylogenetic and sympatric congener, M. andamanensis, consequently reporting the first-ever larval description for M. andamanensis. For the first time also for minervaryan frogs, we record that M. charlesdarwini lays eggs on the inner walls of tree holes, and the tadpoles possess morphological adaptations for a phytotelmonous life. Their unique features, such as tail-to-body ratio >2.2, reduced labial tooth rows (LTRF 1/1), acutely pointed serrations in the jaw sheath, and the medial portion of the upper sheath broadly arched and that of the lower sheath U-shaped, justify adding a new larval morphotype to the genus Minervarya. In contrast, M. andamanensis breeds and undergoes development in ground water puddles and ponds, a common trait for other known minervaryan species. Furthermore, our study generates new knowledge on the amplexus, oviposition site, and early embryonic development in these species. The deeper understanding of the biology and habitat requirements contributes additional traits for future systematic and evolutionary studies, and helps guide conservation assessments for these two species endemic to a handful of islands in the Andaman Archipelago.

A rare neurological presentation of emphysematous pyelonephritis.

Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney with features of air formation in the pelvicalyceal system, renal parenchyma, and surrounding structures. Although septic embolization has been reported to occur in distant organs, air pockets occurring intracranially leading to neurological manifestations in EPN have not been reported in the literature. We present a case report of a patient with EPN showing air pockets in renal parenchyma, pelvicalyceal system, renal vein, inferior vena cava, and multiple intracranial venous sinuses, presenting predominantly with neurological symptoms. This patient was aggressively managed with antibiotics, ureteral stenting, and drainage of the right kidney.

Hiding in Plain Sight: Rain Water Puddles in Nicobar Islands of India Reveal Abundance of a New Frog Species of the Genus Microhyla Tschudi, 1838 (Anura: Microhylidae).

Recent studies on frogs of the Microhyla heymonsi species complex have demonstrated that high genetic variation exists among its various known populations from regions across Asia. We assessed the taxonomic identity of the Nicobar population of Microhyla cf. heymonsi and compared it to the typical Microhyla heymonsi from Taiwan and the two recently described species in this complex from Vietnam. Our study demonstrates that the Nicobar population is both genetically and morphologically divergent and warrants recognition as a new species, which we formally describe here as Microhyla nakkavaram sp. nov. The new species is closely related to M. daklakensis, M. heymonsi, and M. ninhthuanensis, but diagnosable from all three species by a suite of morphological characters, such as the presence of two small tubercles at mid-dorsum along with ( )-shaped markings, length of finger I longer than half the length of finger II, presence of three distinct metacarpal tubercles on hand, rudimentary foot webbing, as well as its slender body shape, granular dorsal skin texture, and other colour characters and body markings. Statistical analyses based on multiple morphometric characters also clearly separate our new taxon from M. heymonsi, with which it was previously confused. Our phylogenetic analyses based on the mitochondrial 16S rRNA locus find Microhyla nakkavaram sp. nov. to be nested in the Microhyla achatina species group, where it is delimited as a distinct species. This lineage shows genetic distances of ≥ 3.5% from all the other known congeners. Currently, the known distribution of the new taxon is restricted to the southernmost group of Nicobar Islands-Great Nicobar, Kondul, and Little Nicobar-where it is found in abundance across a wide range of habitats during the monsoon season. Our study underlines the need to reassess the identity of all the known populations of M. 'heymonsi' from other regions in Southeast and East Asia. To facilitate future taxonomic work in the light of our and other recent findings, we also provide a detailed redescription and revised diagnosis for M. heymonsi based on morphological examination of its century-old type material originating from Taiwan.

A tiny new species of Microhyla Tschudi, 1838 (Amphibia: Anura: Microhylidae) from Belitung Island and Southeastern Sumatra, Indonesia.

A tiny new species of narrow-mouthed frog of the genus Microhyla is described from the island of Belitung and southeastern Sumatra, Indonesia. The most distinctive feature of the new frog is its diminutive adult size, snout-vent length ranging only from 12.3 to 15.8 mm in adult males. Phylogenetic analyses based a fragment of the mitochondrial 16S rRNA gene, along with detailed morphological and acoustic comparison differentiate the new taxon from all known congeners. The new species, formally described as Microhyla sriwijaya sp. nov., is a member of the M. achatina species group and the sister taxon to M. orientalis. It is diagnosable from other congeners by a combination of characters: (1) smaller male snout-vent size 16 mm; (2) snout obtusely rounded in dorsal view; (3) absence of mid-dorsal line and skin fold; (4) first finger reduced (finger I length less than half of finger II length); (5) dorsum with a prominent dark median mark extending posteriorly, narrow anteriorly near the level of the shoulder and expanding dorsolaterally up to the vent; margins of the dorsal marking concave with broad reddish-brown or orange colouration on either side; (6) foot webbing rudimentary, reaching just up to the first subarticular tubercle on all toes; (7) dorsal skin with prominent tubercles, especially in life; (8) tibiotarsal articulation of adpressed limb reaching beyond the snout tip; and (9) males produce a single type of call with pulsatile temporal structure, calls of relatively short duration ranging between 31.862.8 s, with two to three pulses delivered at a rate ranging between 32.236.0 pulses per second, and the mean overall dominant frequency of 4.3 kHz. The uncorrected pairwise genetic distances between Microhyla sriwijaya sp. nov. and all other known congeners are > 3.8% for the studied 16S gene fragment. The new species was discovered from wayside rural areas with oil palm plantations at four localities in the small island of Belitung (type locality), and from coffee plantation and secondary forest at Lampung in southeastern Sumatra. It is not known from any protected area and appears to be threatened due to tin mining activity, intensive logging, oil palm, and other commonly practiced agriculture activities.

Urethral duplication with congenital megacystis and obstructive megaureter - A rare association.

Urethral duplication (UD) in a female is a rare congenital anomaly. Although UD is commonly associated with other congenital anomalies of the urinary tract, its association with congenital megacystis with obstructive megaureter has not yet been reported. We present the case of a 9 year old girl child with complete sagittal duplication of the urethra associated with congenital megacystis and left obstructive megaureter.

An integrative approach to infer systematic relationships and define species groups in the shrub frog genus Raorchestes, with description of five new species from the Western Ghats, India.

The genus Raorchestes is a large radiation of Old World tree frogs for which the Western Ghats in Peninsular India is the major center for origin and diversification. Extensive studies on this group during the past two decades have resolved long-standing taxonomic confusions and uncovered several new species, resulting in a four-fold increase in the number of known Raorchestes frogs from this region. Our ongoing research has revealed another five new species in the genus, formally described as Raorchestes drutaahu sp. nov., Raorchestes kakkayamensis sp. nov., Raorchestes keirasabinae sp. nov., Raorchestes sanjappai sp. nov., and Raorchestes vellikkannan sp. nov., all from the State of Kerala in southern Western Ghats. Based on new collections, we also provide insights on the taxonomic identity of three previously known taxa. Furthermore, since attempts for an up-to-date comprehensive study of this taxonomically challenging genus using multiple integrative taxonomic approaches have been lacking, here we review the systematic affinities of all known Raorchestes species and define 16 species groups based on evidence from multi-gene (2,327 bp) phylogenetic analyses, several morphological characters (including eye colouration and pattern), and acoustic parameters (temporal and spectral properties, as well as calling height). The results of our study present novel insights to facilitate a better working taxonomy for this rather speciose and morphologically conserved radiation of shrub frogs. This will further enable proper field identification, provide momentum for multi-disciplinary studies, as well as assist conservation of one of the most colourful and acoustically diverse frog groups of the Western Ghats biodiversity hotspot.

New insights on the systematics and reproductive behaviour in tree frogs of the genus Feihyla, with description of a new related genus from Asia (Anura, Rhacophoridae).

The taxonomy of the Asian tree frog genus Feihyla has been in a state of flux ever since its proposal in 2006. Allocation of species to Feihyla remains confusing, particularly with respect to the closely related genus Chirixalus (formerly Chiromantis sensu lato). At the same time, several Chirixalus species are known only from cursory descriptions and remain poorly studied. In this study, we review the systematics of the genus Feihyla and clarify the generic placement of its members along with all other species currently assigned to Chirixalus. Based on integrative evidence gathered from new collections, examination of types and original descriptions, morphological comparisons, phylogenetic relationships inferred from a multi-gene (three mitochondrial + two nuclear) 1,937 bp dataset, as well as reproductive modes including egg-laying, nesting behaviour, and clutch morphology, our results show that the six species formerly attributed to Feihyla represent three morphologically and phylogenetically distinct groups: (1) the type species of the genus, F. palpebralis, along with F. fuhua constitute the Feihyla palpebralis group or Feihyla sensu stricto; (2) F. inexpectata and F. kajau represent the Feihyla vittiger group and are closely related to the Feihyla palpebralis group; (3) 'F. hansenae' and 'F. vittata' constitute another distinct and reciprocally monophyletic lineage, more closely related to Chirixalus + Chiromantis. In light of long-standing taxonomic confusions and unresolved phylogenetic relationships, we propose recognition of a new genus to accommodate 'F. hansenae' and 'F. vittata' in order to stabilise the classification of several Asian rhacophorid species that have been frequently confused and transferred within the Chirixalus-Chiromantis-Feihyla complex. Based on integrative evidence, eight species previously attributed to the genus Chirixalus or Feihyla are formally transferred to Rohanixalus gen. nov., two Chirixalus members are allocated to Feihyla, and one synonymised with Rhacophorus bipunctatus. In addition, we report the first member of the tree frog family Rhacophoridae from the Andaman Islands of India-Rohanixalus vittatus, along with description of its male advertisement call, reproductive behaviour including parental care by the female, and larval morphology. Extended distributions are also provided for Rohanixalus species across Northeast India. The study further reveals the presence of potentially undescribed diversity in the new genus. Altogether, the revised classification and novel insights presented herein will facilitate a better working taxonomy for four phylogenetically distinct but morphologically related groups of Old World tree frogs.

Newer variants of retroaortic left renal vein.

The left renal vein (LRV) passing behind the abdominal aorta is termed as a retroaortic LRV (RLRV) and it is a relatively uncommon condition. Since the left kidney is preferred in the setting of live donor kidney transplantation, urologists must be familiar with the anomalies of the LRV. There are four variants of RLRV mentioned in the literature. However, we came across two newer variants of RLRV in two donors for renal transplantation. Both donors underwent successful left donor nephrectomy.

A rare case of small cell neuroendocrine tumor of the urinary bladder.

Small cell neuroendocrine tumor of the bladder is a rare tumor characterized by poor differentiation and high aggressiveness. Very few cases worldwide have been reported till date. Recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. We report a case of small cell neuroendocrine carcinoma of the bladder diagnosed after transurethral resection of bladder tumor, then followed by adjuvant chemotherapy for six cycles and awaiting radical cystectomy.

A new Microhyla species (Anura: Microhylidae) from riparian evergreen forest in the eastern Himalayan state of Arunachal Pradesh, India.

A new frog species of the genus Microhyla (Anura, Microhylidae) is described from riparian mid-elevation (860 m asl) evergreen forest in Namdapha National Park, located in the eastern Himalayan state of Arunachal Pradesh, India. The new species can be morphologically distinguished from other congeners by a suite of characters such as adult size, dorsal and lateral colouration and markings, snout shape, foot webbing, and digit tip morphology. Phylogenetically, the new species is more closely related to some of the smallest known members of the genus. It forms a deeply divergent sister lineage to the clade containing members of the Microhyla zeylanica species group that are restricted to Peninsular India and Sri Lanka, and shows sequential relationship with Southeast Asian species M. superciliaris, followed by clade containing M. aurantiventris + M. butleri. The discovery indicates that novel taxa representing distinct evolutionary lineages still remain to be formally described in the genus Microhyla, especially from less explored regions such as the eastern Himalayan forests in Northeast India.

Rediscovery of Micryletta inornata (Boulenger, 1890) from Sumatra: redescription, molecular identity, and taxonomic implications.

Micryletta inornata (Boulenger 1890), the type species of the genus Micryletta, was originally described from the island of Sumatra in Indonesia. Subsequently, this species has been widely reported from Sundaland (Sumatra and Malay Peninsula), Indo-China, Northeast India and South Andaman, up to southern China and Taiwan. However, since the original description there has been no further report of this species from the type locality or the island. During a herpetofaunal survey in Sumatra, several specimens that are morphologically concordant with the original description and the syntypes of M. inornata were found, and thus the species was rediscovered after 125 years. Here, we provide a redescription of the species based on the freshly collected specimens, along with a detailed morphological and molecular comparison with known congeners. Further, using molecular data from the mitochondrial 16S rRNA gene, our study recovered the Sumatran M. inornata as a phylogenetically distinct lineage from all other populations previously referred to this species. This confirms that all known Micryletta 'inornata' populations from regions outside Sumatra constitute several other lineages representing either new species or previously available names currently considered as synonyms, consequently requiring taxonomic validation in the future.

Complete situs inversus - is it a contraindication for organ donation?

Complete situs inversus, (SI), the total transposition of thoracic and abdominal organs, is rare and is considered a contraindication for organ donation. We report a patient of complete SI, who underwent donor nephrectomy. A 21-year-old male, without significant medical history, presented for voluntary living-unrelated renal donation and was found to have complete SI on evaluation and underwent right donor nephrectomy. The recipient is doing well on the follow-up. Meticulous surgical planning while selecting kidneys would enable renal donation even in cases of complete SI.

Author Correction: New microhylid frog genus from Peninsular India with Southeast Asian affinity suggests multiple Cenozoic biotic exchanges between India and Eurasia.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Multiple Independent Recruitment of Sodefrin Precursor-Like Factors in Anuran Sexually Dimorphic Glands.

Chemical signaling in animals often plays a central role in eliciting a variety of responses during reproductive interactions between males and females. One of the best-known vertebrate courtship pheromone systems is sodefrin precursor-like factors (SPFs), a family of two-domain three-finger proteins with a female-receptivity enhancing function, currently only known from salamanders. The oldest divergence between active components in a single salamander species dates back to the Late Paleozoic, indicating that these proteins potentially gained a pheromone function earlier in amphibian evolution. Here, we combined whole transcriptome sequencing, proteomics, histology, and molecular phylogenetics in a comparative approach to investigate SPF occurrence in male breeding glands across the evolutionary tree of anurans (frogs and toads). Our study shows that multiple families of both terrestrially and aquatically reproducing frogs have substantially increased expression levels of SPFs in male breeding glands. This suggests that multiple anuran lineages make use of SPFs to complement acoustic and visual sexual signaling during courtship. Comparative analyses show that anurans independently recruited these proteins each time the gland location on the male's body allowed efficient transmission of the secretion to the female's nares.

A new species of Micryletta frog (Microhylidae) from Northeast India.

We describe a new species of frog in the microhylid genus Micryletta Dubois, 1987 from Northeast India based on molecular and morphological evidence. The new species, formally described as Micryletta aishani sp. nov., is phenotypically distinct from other congeners by a suite of morphological characters such as brown to reddish-brown dorsum; dorsal skin shagreened with minute spinules; snout shape nearly truncate in dorsal and ventral view; a prominent dark streak extending from tip of the snout up to the lower abdomen; ash-grey mottling along the margins of upper and lower lip extending up to the flanks, limb margins and dorsal surfaces of hand and foot; tibiotarsal articulation reaching up to the level of armpits; absence of outer metatarsal tubercles; and absence of webbing between toes. Phylogenetic relationships within the genus are inferred based on mitochondrial data and the new taxon is found to differ from all the recognised Micryletta species by 3.5-5.9% divergence in the mitochondrial 16S rRNA. The new species was found in the states of Assam, Manipur, and Tripura, from low to moderate elevation (30-800 m asl) regions lying south of River Brahmaputra and encompassing the Indo-Burma Biodiversity Hotspot. The discovery validates the presence of genus Micryletta in Northeast India based on genetic evidence, consequently confirming the extension of its geographical range, westwards from Southeast Asia up to Northeast India. Further, for nomenclatural stability of two previously known species, Microhyla inornata (= Micryletta inornata) and Microhyla steinegeri (= Micryletta steinegeri), lectotypes are designated along with detailed descriptions.

Massive bilateral renomegaly with maintained renal morphology in an infant.

Massive bilateral renomegaly with maintained renal morphology in infants is a rare entity. We present the images of a A 9-month-old female child who presented with massive bilateral renomegaly with maintained renal morphology due to acute lymphoblastic leukemia.

New microhylid frog genus from Peninsular India with Southeast Asian affinity suggests multiple Cenozoic biotic exchanges between India and Eurasia.

Anurans in Peninsular India exhibit close biogeographical links with Gondwana as well as Laurasia, often explainable by the geological history of the Indian subcontinent; its breakup from Gondwanan landmasses followed by long isolation that resulted in diversification of endemic lineages, and subsequent land connections with Asia that enabled dispersal of widespread groups. Although widely distributed, the frog subfamily Microhylinae mostly comprises of geographically restricted genera found either in Southeast and East Asia or Peninsular India and Sri Lanka. Here we report a previously unknown microhylid from the Western Ghats in Peninsular India with closest relatives found over 2,000 km away in Southeast Asia. Based on integrated evidence from mitochondrial and nuclear DNA, adult and tadpole morphology, hand musculature, male advertisement call, and geographical distance, we recognize this enigmatic frog as a distinct new species and genus endemic to the Western Ghats. The discovery of Mysticellus franki gen. et sp. nov. and its close evolutionary relationship with the Southeast Asian genus Micryletta also provide insights on the biogeography of Microhylinae. Genus-level divergences within the subfamily suggest multiple Cenozoic biotic exchange events between India and Eurasia, particularly through postulated Eocene land bridges via Southeast Asia prior to accretion of the two landmasses.

Cryptic diversity within the Megophrys major species group (Amphibia: Megophryidae) of the Asian Horned Frogs: Phylogenetic perspectives and a taxonomic revision of South Asian taxa, with descriptions of four new species.

The Megophrys major species group (MMSG) is composed of typically medium to large sized frogs. Within the genus, it is the most geographically widespread clade ranging from the western Himalayas to southern Indochina. In this study, we examined in detail the extent of cryptic diversity within the MMSG-Indian populations based on molecular data (up to ten genes) using multigene concatenation and coalescent-based phylogenetic techniques, species delimitation analyses and extensive morphological data.Molecular evidence suggests a high level of hidden cryptic diversity within the MMSG, particularly within the M. major species complex (MMC), highlighting overlapping distributions, a case of potential mitochondrial transfer between two species, and tree topology discordance between phylogenetic methods and mitochondrial and nuclear data sets. Most analyses indicated distinct eastern and western clades in the MMC, and that the western clade may further divide into a northern and a southern subclade.A detailed taxonomic review of Indian members of the Megophrys major species group is provided. Previously undocumented complex nomenclatural issues involving known species are highlighted and resolved. Megophrys monticola is taxonomically redefined for the first time as a valid species since its synonymy with M. parva in 1893. The taxonomic status of two recently described species, Xenophrys katabhako and X. sanu are discussed in light of increased molecular and morphological sampling, and are synonymised with M. monticola. Megophrys monticola and M. robusta are redescribed based on their original type specimens and recently collected material. Megophrys major is neotypified and M. robusta lectotypified to remove prevailing nomenclatural instability. Four new large sized Indian MMC species are formally described from the Northeast Indian states of Arunachal Pradesh, Meghalaya and Nagaland, and Myanmar. All South Asian MMSG species are morphologically diagnosed from known congeners in the group. The geographic distributions of all taxa discussed are significantly redefined based on the revised taxonomy and extensive literature review. Morphological and molecular evidence suggests that Megophrys major sensu stricto might be endemic to Northeast India; M. glandulosa is formally removed from the Indian and Bhutan species checklists. Numerous misidentifications in literature are highlighted and corrected. In order to reduce future misidentifications of species reported from surrounding regions, high definition images of the holotypes of three Chinese species, M. glandulosa, M. medogensis and M. zhangi are provided for the first time, and a detailed description of Myanmar specimens of M. glandulosa is also given. This study provides the principle foundation for further research into the taxonomic status of the remaining, currently undescribed MMC taxa from Southeast Asia.